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Alabama Doctors Host Two Telethons to Answer Viewers’ Questions About COVID-19 Vaccines

Alabama Doctors Host Two Telethons to Answer Viewers’ Questions About COVID-19 Vaccines

Last Thursday, doctors with the Medical Association of the State of Alabama and the Alabama Chapter of the American Academy of Pediatrics answered questions from over 200 callers about the safety and effectiveness of COVID-19 vaccines during newscasts on WBRC Fox 6.

Yesterday another group of our physicians went live on air with WKRG in Mobile and answered hundreds of more calls in regard to the vaccine.

Viewers of the television stations’ newscasts were invited to call in and speak one-on-one with a doctor about the vaccines.

“We were grateful for this opportunity to answer questions, allay fears and encourage people to get vaccinated.  It’s perfectly understandable to have questions and want more information.  As physicians, we want to do all we can to answer those questions and assure people that the vaccines are safe and effective,” said Dr. Aruna Arora, the President of the Medical Association.

Many callers had questions about the potential side effects of the vaccines, as well as how getting vaccinated could affect their underlying medical conditions.  Others asked how long protection from a COVID-19 vaccine lasts, if the vaccines are safe for children, and if they needed to get vaccinated after already having had COVID.

The Medical Association and the Alabama Chapter of the American Academy of Pediatrics are planning to do more vaccine call-in programs with television stations throughout the state. 

“We want to do all we can to help people get factual information about the vaccines,” said Dr. Arora.

In addition to Dr. Arora, other doctors who participated in the effort in Birmingham were: Dr. Hernando Carter, Dr. Aubrey Coleman, Dr. Candice Dye, Dr. Michael Saag, and Dr. Wesley Willeford.

Physicians who participated in Mobile included Dr. Michael Chang, Dr. Nina Ford Johnson, Dr. Peter Lutz, Dr. Katrina Skinner, and Dr. Prince C. Uzoije. Thank you to all who were involved!

Posted in: Coronavirus, Members

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No Honor Among Thieves

No Honor Among Thieves

Most Americans will likely never forget where they were in March of 2020 when the world seemingly shut down.  While many used that time to reflect, enjoyed down time with family or even binge watched streaming services, health care workers geared up to save the lives of people impacted by COVID-19.  The novelty of this coronavirus posed exceptional challenges, placed unparalleled strain on the health care industry and exposed vulnerabilities.

One vulnerability in particular has, does and will continue to be a significant risk.  That threat is cybercrime.  It is as relentless as it is lucrative, and it has taken the health care industry by storm during a time when resources are low, and distractions are high.

DIGITAL CALM BEFORE THE STORM

In an almost unbelievable twist, some major cybercrime groups promised a “ceasefire” on cybersecurity attacks of the health care industry at the beginning of the pandemic.  DoppelPaymer Ransomware stated that they “always try to avoid hospitals…nursing homes” but if they happened to be responsible for a ransomware attack of a health care provider during the pandemic, they would provide a decryptor key free of charge. Likewise, Nefilim Ransomware took the same approach.  However, groups like Netwalker Ransomware and Maze promised not to intentionally target health care facilities, but would not commit to decryption if a health care entity was inadvertently impacted. 

While the alleged truce made by some of the larger cybercriminal groups may have appeared to be altruistic, the motivation may have been totally self-serving. During a global crisis, these groups likely decided that staying below the radar of law enforcement and military agencies was more about self-preservation than kindness to their fellow man.

CYBERCRIMINAL LEAVY BREAKS

While hopes were high that a global pandemic would cause bad actors to have mercy on mankind, data reflects that cybercrimes escalated during the pandemic.  On October 28, 2020, the Federal Bureau of Investigation (FBI), Cybersecurity and Infrastructure Security Agency (CISA) and the Department of Health and Human Services (HHS) issued a joint advisory warning of an “increased and imminent cybercrime threat to U.S. hospitals and health care providers.”  It further stated that these bad actors were producing attacks which caused “data theft and disruption of healthcare services.”

As the global threat of cybercriminal activity proliferates within the health care sector, the industry must find ways to fight back.  One way that the health care industry can stand up against these persistent threats is more investments in their information security infrastructure, similar to that of the financial sector. These investments should include stronger password requirements, endpoint protection, and multi-factor authentication. 

MITIGATE RISK

Every effort must be made to determine and mitigate risk to protected health information.  There are several proactive measures that health care entities can take to decrease their risk of inappropriate disclosures of patient data.  Those measures include, but are not limited to, the following:

  • Invest in Anti-Virus Protection Software – Anti-virus protection software is a tool that can help entities detect and neutralize threats.  Most entities prefer efficiency.  This software will assist by filtering out malware which often slows down information system processes.  It has the added benefit of protecting your investment and allowing you to avoid the expense of purchasing new operating systems should your existing system become damaged due to malware.
  • On-Site and Off-Site System Backup – Federal regulations require covered entities to ensure on-site and off-site backup.  Should an entity become a victim of a ransomware attack or be forced to pivot to emergency operations, it is necessary to have backup systems that allow the entity to access and utilize reliable data.
  • Workforce Training – There is no greater defense to cyber threats than a well-trained workforce.  Entities should ensure that cybersecurity threats are emphasized to workforce members in refresher training so that employees are able to appropriately identify and report suspicious activity.
  • Segregation of Data – Entities should ensure that they are complying with the Minimum Necessary Rule for access to their information systems.

The COVID-19 pandemic has produced significant uncertainty in the health care environment and highlighted the need for renewed emphasis on protecting patient data.  HIPAA covered entities should use this time to assess whether they are operating in compliance with the Privacy Rule, Security Rule and Breach Notification Rule.  Likewise, they should reassess their Risk Analysis to ensure that it is HIPAA-compliant and take necessary action to avoid unauthorized disclosures. 

Samarria Dunson (samarria@dunsongroup.com) is attorney/principal of Dunson Group, LLC, a health care compliance consulting and law firm in Montgomery, Alabama.  She is also Of Counsel with the law firm of Balch & Bingham, LLP.

www.dunsongroup.com

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Medical Association Supports Continued Funding for Maternal Death Investigations

Medical Association Supports Continued Funding for Maternal Death Investigations

‘Shocking’ Nearly 70% of Deaths Are Preventable, Experts Say      

MONTGOMERY – The Medical Association of the State of Alabama today joined Alabama legislators in calling for continued state funding to investigate why Alabama mothers die from childbirth and pregnancy complications at more than double the rate of women nationally.

The funding for this research, which was first appropriated by Governor Kay Ivey and the Alabama Legislature just last year, enables the Alabama Maternal Mortality Review Committee (AL-MMRC) to pay for additional autopsies and costs associated with compiling case files and reviewing medical records of Alabama mothers who died up to a year after giving birth. While the AL-MMRC was launched in 2018, it relied solely on the work of volunteers to undertake such reviews until last year.

Appearing at a press conference in Montgomery today, Aruna Arora, MD, MPH, President of the Medical Association, applauded Senator Linda Coleman-Madison for sponsoring a resolution spotlighting the findings of the first AL-MMRC report and acknowledging continued funding of the program is critical to saving Alabama mothers.

“The recent report of the Maternal Mortality Review Committee was both shocking and informative,” said Dr. Arora. “That nearly 70 percent of the deaths could have possibly been prevented highlights the inequities of our current health system and underscores the need for the continued annual review to determine why these high numbers of deaths are occurring. Funding the review committee provides invaluable insight into the deaths of Alabama mothers and will enable the experts to develop specific strategies to save lives in the future.”

For its initial report, the AL-MMRC undertook a review of all maternal deaths in the state from 2016. Highlights from that report include:

  • 36 mothers lost their lives within one year of the end of pregnancy and 36 percent of those deaths were directly related to the pregnancy.
  • Nearly 70 percent of deaths were determined to be preventable.
  • Mental health and substance use disorders were identified as key contributors in almost 50 percent of deaths.
  • 67 percent of deaths occurred 43 to 365 days after the end of pregnancy.

Additionally, the AL-MMRC also made more than 100 recommendations to improve maternal health. Chief among those recommendations is for the state to expand Medicaid. 

“Right now, amid a global pandemic, affordable and accessible health care is more important than ever,” continued Dr. Arora. “Just last week, new research found the risk of maternal mortality to be 22 times higher in women who tested positive for COVID-19 during pregnancy. Thus, with other research showing reduced maternal mortality rates and positive maternal health outcomes in states that expanded Medicaid, the decision to expand here in Alabama is abundantly clear.”

The Medical Association appreciates Governor Ivey’s recommendation for initial funding for the review committee for 2020-21 as well as the continued efforts from legislative leaders like Senator Coleman-Madison, Rep. Laura Hall, and others.                                                                                 

The Medical Association also launched an online social media effort aimed at increasing awareness of maternal health needs with #SaveAlMoms and a website:  www.alabamamedicine.org/SaveAlMoms/.


Posted in: Advocacy, Members, Official Statement

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Physician Recruitment Agreements – What You Need to Know

Physician Recruitment Agreements – What You Need to Know

by Howard E. Bogard

Both the federal Anti-kickback Statute and the Stark Law allow a hospital to provide certain financial assistance to aid a medical practice in its efforts to recruit and hire a new physician. Financial assistance can take many forms, including a collection guarantee, net income guarantee and/or payments with respect to a physician’s moving expenses, school debt and marketing.  A recruitment agreement reflecting financial assistance is typically signed by the medical practice, physician and hospital and is structured as a loan that is forgivable as long as the physician practices medicine in the hospital’s service area for a defined time period. The amount of financial assistance cannot take into account past or future referrals from the recruited physician (or medical practice) to the hospital.

In order for a hospital to provide a medical practice financial assistance to recruit and hire a new physician, the hospital must first determine that there is a documented need in the community for the physician’s specialty.  Once confirmed, the arrangement must be in writing and the physician must “relocate his or her medical practice” to the “geographic area served by the hospital” to become a member of the hospital’s medical staff. With some exceptions for hospitals located in rural areas, the geographic area served by a hospital is the area composed of the lowest number of contiguous zip codes from which the hospital draws at least 75 percent of its inpatients.  A physician will be considered to have relocated his or her medical practice if the physician moves his or her practice at least 25 miles and into the geographic area served by the hospital or the physician moves his or her practice into the geographic area served by the hospital and the physician derives at least 75 percent of revenues from patients not seen or treated by the physician at his or her prior medical practice site. There are also exceptions for residents or physicians who have been in practice one year or less or for physicians who meet other requirements.  The main point is that it is not permissible for a hospital to provide recruitment assistance with respect to a physician who is already working in the hospital’s service area.  

A common form of recruitment assistance is a collection or net income guarantee that runs for one or two years after the physician is first employed by the medical practice.   In either case, the recruitment agreement “guarantees” that the physician will generate a certain amount of revenue to satisfy a collection “target” or a net income “target”.  If the physician’s collections are not high enough in a particular month to meet the target amount, the hospital pays the difference.  With respect to a net income guarantee, the target is based on the physician’s collections after certain “direct expenses” are subtracted.  By law, direct expenses can only consist of new, incremental expenses incurred by the medical practice by virtue of the physician’s employment. Examples of new, direct expenses include the cost of the physician’s compensation and benefits, license fees and dues, malpractice insurance and other costs incurred by the medical practice to the extent that such expenses increase directly as a result of the physician’s employment.  Existing expenses, such as office rent and personnel costs, cannot be included as a direct expense. 

When reviewing a physician recruitment agreement, it is important to not only review the financial terms of the assistance but also to consider the following:

 Commitment Period – What is the length of time the recruited physician must practice in the hospital’s geographic service area for the recruitment assistance loan to be forgiven? The typical time period is one to three years after the financial assistance period ends.

   Repayment Obligations – It is important to review whether the medical practice, physician or both are obligated to repay the loan upon a default of the recruitment agreement.  Oftentimes, if the physician is the direct recipient of the loan proceeds, such as moving expense reimbursement and payments for student loans, the physician will be solely responsible. However, a collection or net income guarantee will often obligate both the physician and medical practice to repayment in the event of a default. A promissory note is often signed by the physician and sometimes the medical practice to secure the repayment of the loan.

Physician Obligations – While the physician will need to remain on the medical staff of the hospital during the term of the recruitment agreement, it is important to determine if other obligations are imposed on the physician.  Often, during the term of the recruitment agreement the physician will be obligated to certain hospital call obligations and restricted from having an ownership interest in a provider that competes with the hospital. 

Security Interest – To secure the recruitment agreement loan sometimes the hospital will want a security interest in the medical practice’s accounts receivable generated by the recruited physician. These provisions must be carefully reviewed since medical practices often pledge their accounts receivable as collateral to a bank or other financial institution.

A physician recruitment agreement can provide a medical practice significant financial assistance with the recruitment and hiring of a new physician. However, the agreement may also impose significant financial restrictions and penalties on both the medical practice and physician if the terms of the agreement are breached.  Any recruitment agreement should be carefully reviewed and negotiated.

Howard Bogard is a Partner at Burr & Forman LLP and chairs the firm’s Health Care Practice Group. He can be reached at 205-458-5416 or at hbogard@burr.com.

Posted in: Legal Watch, Management, Members, MVP

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Partnering with ALAHA to Celebrate 2021 Doctors’ Day

Partnering with ALAHA to Celebrate 2021 Doctors’ Day

Today is a day set aside nationwide to honor the physicians who care for us every day of the year.  Doctors’ Day was established on March 30 in 1934, and later in 1991, President George H.W. Bush proclaimed National Doctors’ Day as a time for the nation to celebrate the dedication and leadership of physicians.  In Alabama, today is a time to formally recognize our state’s nearly 17,000 licensed physicians serving millions of residents through private practice, in hospitals, in research, and in other health care facilities.

“Physicians often lead their patients and communities through some of life’s most challenging moments and the past year has proved to be even more demanding,” said John S. Meigs, Jr., MD, President of the Medical Association. “On behalf of the Medical Association, I wanted to express my appreciation for the thousands of physicians throughout Alabama who have sacrificed so much during the COVID-19 pandemic. A simple ‘thank you’ cannot convey the gratitude that we feel towards Alabama’s healthcare providers. Physicians have been and continue to be on the front lines and have demonstrated unparalleled selflessness, dedication, and courage. This pandemic has exposed shortcomings in our healthcare system but has also highlighted many opportunities for growth. I am confident that as we enter a new year, we can work together to reach a new normal. If you want to know how you can thank your physician, continue to wear your mask, socially distance, and use other precautionary measures.”

“Healthcare today is more complex than ever,” said Alabama Hospital Association President, Dr. Don Williamson, MD. “Even without the disruption of a global pandemic, physicians are faced with more challenges and pressure than ever before. What our healthcare professionals have endured over the past year has been monumental, and we could never adequately express how thankful we are for them. Physicians have faced a giant this year, and countless Alabamians are still with us today because of the dedication, selflessness, and expertise of a local physician. While we can end the month of March 2021 with a much more positive outlook than March 2020, let’s not forget that there is still much risk for our healthcare workers. Please continue to wear a mask and use precautions. It’s the right and responsible thing to do.”

We all understand the critical role our doctors and other health professionals have played in leading us through this past year. Help us thank our doctors today for what they do for the health of all Alabamians!

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Op-ed: Alabama physicians face challenges head-on during vaccine rollout

Op-ed: Alabama physicians face challenges head-on during vaccine rollout

By: John Meigs, Jr., MD, President – Medical Association of the State of Alabama

Because of a seemingly slow rollout of the COVID-19 vaccine, physicians have started to hear many concerns from their patients. Understandably, the people of Alabama are growing more eager each day to get vaccinated. Physicians were privileged to be included in the first tier of vaccine recipients and remain our patients’ biggest advocate for vaccination against the Coronavirus. 

In addition to issues like staffing shortages, a major obstacle we face is the fact that from week to week, our practices and hospitals are not alerted to when we are getting more vaccines or exactly how many we will receive. Even the Alabama Department of Public Health (ADPH) has no input into the quantity allocated and is typically notified less than 24 hours before the vaccine is shipped. This makes it extremely difficult to set up vaccination and follow-up appointments. 

It’s tempting but comparing Alabama’s response to surrounding states doesn’t necessarily make sense. The number of COVID-19 vaccine doses allocated to Alabama is based on our population and is not determined by how much vaccine is on hand in the state. The number of doses remaining from previous allocations does not affect the number of doses that the Centers for Disease Control and Prevention (CDC) authorizes for Alabama.

Alabama still faces struggles in figuring out the logistics of vaccine distribution and allocation but there are a few things your physician wants you to know about the process.

  • The Federal Government determines the quantity of vaccines that are allocated to the state.
  • There is a shortage of available vaccines in Alabama.
  • There are 326,000 healthcare providers, nursing home residents, law enforcement officers, firefighters and 350,000 persons 75 years of age and older that are currently eligible for the vaccine.
  • The number of first doses of the vaccine shipped to Alabama per week only averages around 50,000 to 60,000.

Wide distribution of the COVID-19 vaccine will take time. While we are anxious for the vaccine to be made available to all Alabamians, physicians also want to urge you to wait until you fall into the appropriate tier. As of January 28th, Alabama is administering vaccines to healthcare workers, residents and staff in long-term care facilities, first responders, and individuals 75 years of age and older. 

We know vaccines are the best bet to slow this pandemic down and get enough folks immunized so the virus won’t spread as easily. However for now, even after we get vaccinated, we need to continue to wear masks and physically distance. We want to protect folks from a disease that can be very deadly. If we all work together, we will be that much closer to getting life back to normal.

Posted in: Coronavirus, Leadership, Members

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Advocacy in Action: Recapping AAFP’s “Day on the Hill”

Advocacy in Action: Recapping AAFP’s “Day on the Hill”

Why Advocacy Matters

Multiple times each legislative session, the Medical Association’s Government Relations team calls and emails physicians asking them to contact their legislator(s) regarding a specific bill or amendment. As evidenced by the Association’s track record of advocacy successes each year, a number of physicians respond to these “calls to action,” but not near as many as needed.

Unfortunately, there is a belief (not only amongst physicians) that an individual’s voice doesn’t matter; that emails to legislators won’t be read; that phone calls to legislators won’t be passed along; or that legislators won’t listen. Whatever the reason, the underlying premise – that an individual’s voice can’t make a difference – is incorrect.

Not only do legislators desire to hear from constituents, they desperately need to hear from physician-constituents on important health topics. Still, many legislators are surprised when they hear from local physicians at all. This must change.

Heeding the Medical Association’s calls to action could not only have lasting impacts on legislators’ positions on a particular issue, but it could also open the door for physicians to weigh in on other health-related topics.

As the old adage goes, “If you’re not at the table, you’re on the menu.” The Medical Association makes it a priority to ensure physicians are at the table, but medicine can’t get there without individual physicians doing their part; our likelihood of continued success on state health policy issues depends on your advocacy.  

AAFP's Advocacy Efforts

In early March – shortly before the legislature shutdown due to COVID concerns – the Medical Association teamed up with the Alabama Academy of Family Physicians (AAFP) and the UAB Rural Scholars Program for a day of advocacy at the State House. Particular topics spotlighted throughout the day were the need for updates to the Rural Physician Tax Credit and increasing funding for the BMSA.

Of those in attendance were Dr. Bill Coleman, Dr. David Bramm, Dr. Holly McCaleb, Dr. Drake Lavender, Wesley Minor, and Whitney Lee. Every single one of these individuals made their presence known throughout the State House and displayed an energy for advocacy. Whether it was a short introduction in the hallway or a private meeting in a legislator’s office, the conviction and effectiveness with which they spoke made a lasting impression on every individual they met.

And their work paid off.

In fact, just a couple months later, when COVID had shut down most government bodies and future budgets were being slashed, state legislators decided not only fully fund the BMSA, but to increase its appropriation by over half-a-million dollars.

In a follow-up email to one of the participants from that day, said this:

You lay out your proof in detail not only as to why BMSA has been a good investment, but why it deserves increased funding based on sound business principles using ROI comparisons. I have been a supporter in the House since the issue was presented, passed, then enacted as statutory law.  I will be a willing ally in keeping these programs funded and growing. . . Thanks for “making my day” with your excellent communication!

 

We are extremely appreciative these individuals took time out of their day to travel to Montgomery and advocate on issues important to them and their peers. We also appreciate Jeff Arrington, Executive Director of AAFP, for his tireless efforts in helping to coordinate this event. The increased funding for BMSA is, no doubt, a direct result of their hard work.

Wesley Minor meets with his Senator, Majority Leader Greg Reed (R-Jasper)

Whitney Lee and Dr. David Bramm meet with Rep. Mike Holmes (R-Wetumpka)

Wesley Minor and Dr. Bill Coleman meet with Rep. Tim Wadsworth (R-Winston)

From left to right: Dr. Holly McCaleb, Dr. Drake Lavender, Dr. David Bramm, Senator Larry Stutts, M.D. ( R-Tuscumbia), Wesley Minor, Whitney Lee, Dr. Bill Coleman, and Jeff Arrington, who discussed the importance of increasing access to care in rural areas through programs like the Board of Medical Scholarship Awards and the Rural Medical Scholars Program.

Posted in: Advocacy, Members, Scholarship

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Five Things to Consider When Selling Your Practice to a Private Equity Firm

Five Things to Consider When Selling Your Practice to a Private Equity Firm

By Howard Bogard, Burr Forman

A growing number of physicians are selling their medical practices to private equity firms in order to “monetize” their practice, as well as to access capital and obtain operational efficiencies. In the Southeast, we are seeing consistent private equity activity in the specialties of anesthesiology, gastroenterology, dermatology, ophthalmology, oncology, ENT, and internal medicine, as well as others. 

 Private equity firms generally use capital from wealthy individuals, pension funds and university endowments to invest in various industries with the goal of obtaining a return on investment of 20% or more.  To start, the private equity firm will purchase a large, well-managed (“platform”) medical practice and thereafter will acquire additional practices in order to increase the number of employed physicians throughout a defined geographic area.  The goal is to grow revenue and decrease cost and then sell the practices within three to seven years of acquisition.

 If you are considering a sale to a private equity firm, there are several things to consider:

  1. Valuation of the Practice.  A private equity firm generally determines the purchase price for a medical practice based on a multiple of EBITDA (earnings before interest, taxes, depreciation, and amortization) as a measure of the operating performance of the practice. The multiple can run anywhere from 4 to 12 times EBITDA, with a platform or larger practice obtaining a multiple on the higher end of the range.
  2. Payment of the Purchase Price.  The purchase price is typically a combination of cash plus “roll-over” equity in the buyer from 10% to 30% of the total purchase price.  For example, if the total purchase price is $10 million, $8 million could be paid in cash at closing and $2 million paid as equity in the buyer.  When the buyer sells, the physicians receive a return on their roll-over equity.  A portion of the purchase price may also be paid by a promissory note with payment contingent on the physicians meeting certain revenue benchmarks.  
  3.  Expect a Change in Compensation. After closing, the physicians will become employees of the private equity buyer. In return for a large up-front purchase price, typically a physician will be paid less in annual compensation as compared to pre-closing compensation amounts, although “guaranteed” salaries for a period of time can be negotiated.  Compensation is based on a variety of factors, including collections from personally performed services, plus a percentage of ancillary revenue and/or a percentage of overall profits. Physicians considering a private equity sale should analyze and compare their expected compensation over a three to five year period in private practice versus the same period under a private equity model, to include the up-front payment.
  4. Penalties for Early Departure.  Typically, a private equity firm will require the selling physicians to sign a five-year employment agreement. In the event a physician leaves employment for certain reasons within a defined time period, the departing physician will be required to repay some of the purchase price he or she received (a “claw-back”).  Typically, the claw-back period runs from three to five years after the start of employment, with more money repaid in the first year of the claw-back as compared to the last year. In addition, the selling physicians are required to sign non-compete and non-solicitation/no-hire agreements that restrict the physician’s ability to compete with the private equity buyer in the event the physician leaves the practice.
  5. Loss of Control.  One of the benefits of being in private practice is that the physician owners make the decisions.  If a practice sells to a private equity firm, a management company (owned by the private equity firm) will manage the practice and will have authority to make essentially all operating decisions, other than clinical/medical decisions, which remain within the control of the physicians.  Oftentimes, there is a clinical management board or committee comprised of physicians and private equity representatives that has authority to address certain issues.  However, if the practice is well run and profitable (hence the reason the private equity firm is interested in the practice), in my experience, the private equity firm does not make significant changes without first consulting with the physicians.

Howard Bogard is a Partner at Burr & Forman LLP and chairs the firm’s Health Care Practice Group.  Howard can be reached at 205-458-5416 or at hbogard@burr.com.

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Physicians Perspective: Dr. Chris Adams Talks Telemedicine

Physicians Perspective: Dr. Chris Adams Talks Telemedicine

Adversity and necessity mandate invention. 

During the COVID-19 pandemic, telemedicine has been transformed almost overnight into a necessary medical tool for remaining connected to our patients.  Without warning, physicians suddenly found themselves in the position of adding communication technologies, learning regulatory requirements, and adapting to an entirely new way of interacting with patients, sometimes reinventing their standard clinic procedures.  Similarly, government and private health care had to modify longstanding obstacles and prohibitions by allowing interstate practice and revising reimbursement policies.

I doubt there is a physician in our state who believes they could have managed their patients through this pandemic without the benefit of telemedicine.  Having said that, telemedicine is not a panacea. 

Practicing in a rural environment, we have discovered that bandwidth challenges are a huge issue.  Older patients also have vision and hearing challenges that make telemedicine less effective than face-to-face visits.  There is still an enormous amount of paperwork involved in conducting a telemedicine visit, it is not simply a matter of “picking up the phone and chatting.”  That is one reason why it is so important to have parity for video and telephone encounters. 

Despite these challenges, most clinicians would like to maintain the availability of this tool as we continue our social and medical confrontation with coronavirus.  At the same time, we also recognize inherent limitations that telemedicine imposes (I just cannot do a good knee exam over the telephone).  The challenge we now face is to define and refine best practices for employing telemedicine.  Part of this effort will require continued advocacy and encouragement of health delivery systems to support telemedicine.  Some of this will also necessitate new legal safe guards for practitioners employing this tool.

As you reflect on how this pandemic has changed your practice, please consider how you can support and contribute to the future of medicine in our state by advocating for your patients and your practice.  It is up to us as clinicians to help mold the future of healthcare delivery.

Posted in: Advocacy, Coronavirus, Members, Technology

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Op-Ed: Alabama Medical Practices Hit Hard by COVID-19, Survey Finds

Op-Ed: Alabama Medical Practices Hit Hard by COVID-19, Survey Finds

By:          John S. Meigs, Jr., MD, President Medical Association of the State of Alabama

In a span of just a few months, the coronavirus pandemic has changed the way we function as a society and has fundamentally altered our healthcare delivery system. It has exacerbated weaknesses in the infrastructure of health care and exposed limitations in current policies at a time when costs are rising and access to care is dwindling.

In an effort to understand these changes and their effects, the Medical Association of the State of Alabama released a survey summary detailing the impact of the novel coronavirus (COVID-19) on medical practices and care delivery.  The survey identified several key findings:

  • Public Health Concerns: Survey data shows that patient volume is down considerably and there are concerns that Alabamians are not going to their physician for routine care, including childhood and adult vaccinations, which will have long term public health consequences.
  • Financial Impact: More than 70% of respondents said COVID-19 has had a severe impact on practice finances, causing layoffs and furloughs and limiting access to care
  • Patient Volume: Nearly 60% said patient volume reductions cut revenues by at least 50%, underscoring the extent to which patients are delaying or skipping necessary care
  • Telemedicine Increase: More than 71% said they’re likely to continue providing telemedicine so long as insurers continue covering the services for patients
  • Liability Concerns: More than 71% are concerned about the potential liability from lack of PPE and patients canceling or delaying procedures and other medical care

In addition, a similar study[1] found that Alabama is ranked sixth in the country in the number of patients that are delaying care. While COVID-19 may change how you receive care, it’s still important to look after yourself by getting the time-sensitive medical care you need to stay healthy.

In light of the findings of the survey, the Medical Association recommends several public policy proposals to combat COVID-19’s effects on physician practices and care delivery:

  1. Allocate state stimulus funds to reimburse practices for COVID-19 related expenses
  2. Expansion of testing, PPE, and cleaning supply availability
  3. Continued coverage of telemedicine by insurers at existing rates
  4. Enactment of “safe harbor” legislation to provide liability protections to health care providers

This pandemic has made telehealth more important than ever, enabling access to care to patients whose needs can be met remotely. Telemedicine has saved lives, helped reduce the spread of the virus, and enabled physicians to care for patients in a time when they might have otherwise been unable to. However, it is not a “silver bullet” and should not be viewed as a total replacement for in-person care.

Whether in a hospital, surgery center, or in a clinic, COVID-19 has drastically changed the care we as physicians provide for our patients. We cannot allow this virus to decimate our already strained healthcare system. Supporting those who care for us is needed now more than ever.

View the complete survey summary by clicking the button above or by using this link: https://masa.informz.net/masa/data/images/2020-Survey-Graphic_Summary-FINAL.pdf

John S. Meigs, Jr., MD, President Medical Association of the State of Alabama


[1] Bean, M., 2020. States Ranked By Percentage Of Americans Delaying Care: Nationwide, 40 Percent Of Americans Are Still Delaying Care, According To A Survey From The U.S. Census Bureau.. [online] Beckershospitalreview.com. Available at: <https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-percentage-of-americans-delaying-care.html> [Accessed 26 August 2020].

Posted in: Coronavirus, Members

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